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Leung CH, Rizoli SB, Trypcic S, Rhind SG, Battista AP, Ailenberg M, Rotstein OD. Effect of remote ischemic conditioning on the immune-inflammatory profile in patients with traumatic hemorrhagic shock in a randomized controlled trial. Sci Rep 2023; 13:7025. [PMID: 37120600 PMCID: PMC10148877 DOI: 10.1038/s41598-023-33681-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023] Open
Abstract
Resuscitation induced ischemia/reperfusion predisposes trauma patients to systemic inflammation and organ dysfunction. We investigated the effect of remote ischemic conditioning (RIC), a treatment shown to prevent ischemia/reperfusion injury in experimental models of hemorrhagic shock/resuscitation, on the systemic immune-inflammatory profile in trauma patients in a randomized trial. We conducted a prospective, single-centre, double-blind, randomized, controlled trial involving trauma patients sustaining blunt or penetrating trauma in hemorrhagic shock admitted to a Level 1 trauma centre. Patients were randomized to receive RIC (four cycles of 5-min pressure cuff inflation at 250 mmHg and deflation on the thigh) or a Sham intervention. The primary outcomes were neutrophil oxidative burst activity, cellular adhesion molecule expression, and plasma levels of myeloperoxidase, cytokines and chemokines in peripheral blood samples, drawn at admission (pre-intervention), 1 h, 3 h, and 24 h post-admission. Secondary outcomes included ventilator, ICU and hospital free days, incidence of nosocomial infections, 24 h and 28 day mortality. 50 eligible patients were randomized; of which 21 in the Sham group and 18 in the RIC group were included in the full analysis. No treatment effect was observed between Sham and RIC groups for neutrophil oxidative burst activity, adhesion molecule expression, and plasma levels of myeloperoxidase and cytokines. RIC prevented significant increases in Th2 chemokines TARC/CCL17 (P < 0.01) and MDC/CCL22 (P < 0.05) at 24 h post-intervention in comparison to the Sham group. Secondary clinical outcomes were not different between groups. No adverse events in relation to the RIC intervention were observed. Administration of RIC was safe and did not adversely affect clinical outcomes. While trauma itself modified several immunoregulatory markers, RIC failed to alter expression of the majority of markers. However, RIC may influence Th2 chemokine expression in the post resuscitation period. Further investigation into the immunomodulatory effects of RIC in traumatic injuries and their impact on clinical outcomes is warranted.ClinicalTrials.gov number: NCT02071290.
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Affiliation(s)
- C H Leung
- The Keenan Research Centre for Biomedical Science and the Department of Surgery, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Li Ka Shing Knowledge Institute 3-305, Toronto, ON, M5B 1W8, Canada
| | - S B Rizoli
- The Keenan Research Centre for Biomedical Science and the Department of Surgery, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Li Ka Shing Knowledge Institute 3-305, Toronto, ON, M5B 1W8, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - S Trypcic
- The Keenan Research Centre for Biomedical Science and the Department of Surgery, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Li Ka Shing Knowledge Institute 3-305, Toronto, ON, M5B 1W8, Canada
| | - S G Rhind
- The Defence Research and Development Canada, Toronto Research Centre, Toronto, Canada
| | - A P Battista
- The Defence Research and Development Canada, Toronto Research Centre, Toronto, Canada
| | - M Ailenberg
- The Keenan Research Centre for Biomedical Science and the Department of Surgery, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Li Ka Shing Knowledge Institute 3-305, Toronto, ON, M5B 1W8, Canada.
| | - O D Rotstein
- The Keenan Research Centre for Biomedical Science and the Department of Surgery, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Li Ka Shing Knowledge Institute 3-305, Toronto, ON, M5B 1W8, Canada.
- Department of Surgery, University of Toronto, Toronto, Canada.
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Nielsen MB, Ravlo K, Eijken M, Krogstrup NV, Bue Svendsen M, Abdel-Halim C, Steen Petersen M, Birn H, Oltean M, Jespersen B, Møller BK. Dynamics of circulating dendritic cells and cytokines after kidney transplantation-No effect of remote ischaemic conditioning. Clin Exp Immunol 2021; 206:226-236. [PMID: 34473350 DOI: 10.1111/cei.13658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022] Open
Abstract
Inflammation resulting from ischaemia/reperfusion injury can cause kidney graft dysfunction, increase the risk of delayed graft function and possibly reduce long-term graft survival. Remote ischaemic conditioning may protect against ischaemia/reperfusion injury and mitigate the immunological response to the graft. We investigated the immunological effects of remote ischaemic conditioning on kidney transplantation from deceased donors in the randomized CONTEXT study. Three circulating dendritic cell (DC) subtypes identified in peripheral blood from kidney transplant recipients [myeloid DCs, plasmacytoid DCs and immunoglobulin-like transcript (ILT)3+ DCs] were measured at baseline, days 1, 3 and 5 and 1 and 3 months after transplantation. We also quantified 21 cytokines at baseline, days 1 and 5 and 3 months after transplantation. Neither DC counts nor cytokine levels differed between patients receiving remote ischaemic conditioning and controls; however, several parameters exhibited dynamic and parallel alterations in the two groups over time, reflecting the immunological response to the kidney transplantation and immunosuppression.
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Affiliation(s)
- Marie B Nielsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Kristian Ravlo
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marco Eijken
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Nicoline V Krogstrup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
| | | | - Chadi Abdel-Halim
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Odense University Hospital, Odense, Denmark
| | | | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Mihai Oltean
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bjarne K Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
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